Opt-in vs. opt-out HIV testing in dental settings: Changing the paradigm

Approximately one quarter of a million people in the US with HIV do not know it. Routine testing is essential to reduce the number infected, who are unaware of their status (Beckwith, et al. 2005). In February, 2010, the Dental Clinic at Lutheran Medical Center, Brooklyn, piloted free rapid oral tests (ROT) for HIV, part of a federal grant. LMC Dental follows newly enacted state legislation, effective September 1, 2010, requiring primary care providers to routinely offer HIV tests to people aged 13 – 64, (http://www.nyc.gov/html/doh/html/pr2010/pr043-10.shtml, 2010).

Patients who accepted, February to September, 2010, (N=111) completed a post-test survey. Notable among descriptive statistics is the percentage of respondents lacking primary care providers (45.57%). According to National Health Interview Survey (Pollack, et al. 2010) of the estimated 3.6 million people who report risk for HIV but have never been tested, 75% have seen a dentist in the past 2 years. Thus, dental clinics provide untapped opportunities for HIV testing. New legislation makes HIV testing routine, not risk-based, enabling greater numbers to test through an opt-out model. (Patton, et al. 2002, Dietz, et al. 2008., Vernillo & Caplan, 2007., National Association of Community Health Centers, 2006, Ramos & Hisiger, ROT In the Dental Clinic, 2010, paper presented at LMC Dental Medicine Faculty Development, September 20-22, 2010). Data from the opt-in approach (implemented 2/1/2010 through 1/31/2010), approximately 40% acceptance, was compared to opt-out rates at 2 Lutheran dental clinics. Results indicated increased acceptance rates with opt-out, 74% (Park Ridge) and 64% (Caribbean).